Underestimation of Helicobacter pylori Infection Rate by Biopsy Urea Broth Test

To the Editor.—  I share the views of Greenberg and Bank¹ that when considering the etiopathological role of Helicobacter pylori in nonulcer dyspepsia one needs to take into account the age of the patients surveyed. However, I fear that the authors might have underestimated the true prevalence of H pylori colonization in their study population by using a single antral biopsy urea broth test. The biopsy urea broth test has recently been compared in a pilot study² with a modified technique, cytological brushing urea broth test, and histologic examination used in our unit and has been shown to underestimate H pylori colonization by 15% (85% sensitivity of biopsy urea broth test and 100% sensitivity of cytologic brushing urea broth test, respectively). The false-negative rate has increased to about 20% in a subsequent larger study (unpublished results). No mention has been made in the article by Greenberg and Bank